Your staff members are your #1 client. How you treat your staff is how the staff will treat your clients. - Tom Cat

In this day of a veterinarian on virtually every corner, the average client has two or more veterinary practices within fifteen minutes of home. All recent surveys show over seventy-five percent of the pet owners give their furry four-legged family status, and a third of those give them people status. These are "stewards" of precious companion animals, and when they call they want "peace of mind", caring compassion, and they want veterinary care, not to be told to stay home.

They deserve two "yes" answer questions for their access desires. It is likely that your better clients even drive past one or two practices just to get to "their veterinarian". It is this type of client bond that must be developed as you build a caring practice, and it starts by the entire staff becoming aware that the human/companion animal bond is the basis of a quality practice philosophy.

A Reminder From Previous Chapters' Discussions

When we discuss a bond-centered practice, we are targeting client-centered patient advocacy by everyone, without any residuals of doctor-centered operations. The staff schedules and operates the facility, and the doctor(s), even if they are owners, stay on schedule as a courtesy to the staff, as well as abide by a clear set of inviolate core values, which include consistent standards of patient care.

The AAHA Standards for Accreditation have a strong set of patient care standards, yet they are only starting point. Each member of the staff should have been provided a pet health insurance policy as a term of employment, after the basic orientation and training phase was completed. The attending Inpatient Nurse Technician (IPNT) and Outpatient Nurse Technician (OPNT) follow any cases with deferred or symptomatic care until resolved on the master problem list. Atypical laboratory findings, or atypical body condition scores, are assigned to an attending nurse to monitor the companion animal until the condition is resolved.

If you cannot accept the quality medicine, team-based, baseline principles of this chapter, the basic premise of this text, these concepts are not designed for your practice. This chapter and text are designed for those who want to differentiate their practice with client-centered, team-based, quality health are delivery.

Cowboy says, "When wiser men are talking, let your ears hang down and listen."
Consultant says, "Our systems have helped over two thousand practices. Want to know why?"

Where Does It Start?

Most of us entered veterinary medicine because we cared about animals, and most every staff member entered this profession because they care about animals. Pet owners have become stewards to their companion animals, because they care about those animals. They access veterinary care, because they want assurance of health, as well as personal peace of mind.

Then veterinary school occurs. People who have lost contact, or do not understand anything about private general practice, train the future veterinarians. They are specialists or specialists in the making, they want forty-five-minute appointments and are supported by the state in most cases. Recent Pfizer studies of thirty-five thousand to thirty-seven thousand clients, three years in a row, showed eighty-five percent to eighty-seven percent of the clients want to be in-and-out of the general practice's consultation room in twenty minutes or less.

Most veterinary teaching hospitals have twice the expense as income, yet no one seems to care. A private practice could never operate with this ratio, yet this is the environment where students are "educated" about the business of veterinary medicine. Students are told, "You cannot afford to do this in practice!" or "Only specialists can do this, so you must refer these cases." And we wonder why most veterinarians seem to discount as a matter of course?

We consulted with one New York practice doing $1.5 million a year, but they had no cash flow (liquidity). They had discounted $200,000, and had not charged for an additional $300,000 of work during the same $1.5 million year. No one can give away one-third of earned dollars and expect to stay in business.

The AAHA publication The Path to High-Quality Care is a wake-up call. It shows in dollars and cents the impact of a practice that is not presenting the "animal needs", as a client-centered patient advocate, on every animal. They still use the word "recommendation", which has been shown time and again to be far less effective than stating the need, writing the need in the medical record with a box ([ ]) behind it, and then waiting for the client response. For example, an entry would look like this: "hwt [ ]".

However a client responds to the "needed" heartworm test, Section One of the AAHA Standards states you are required to document waivers and deferrals. So, the client response could be recorded as:

 W, which equals waiver ("No way, Doc, do not believe in it.").

 D, which equals defer ("Let me think about it. Maybe later, Doc.").

 A which equals appointment ("Need to wait until payday, Doc.").

 X, which equals do it, Doc! and goes inside the box thus: "hwt [x]".

If it is deferred (D), it needs to be followed by the attending nurse until resolved. So, after the box comes the expectation, as stated by the doctor to the client. For example, the notation shows as "hwt [D] 3w", followed by the doctor saying, "We can delay this maybe up to three weeks, while you consider this, but the mosquitos will be getting bad by the end of the month, so we need to start the protection soon, and need the blood test first to ensure Spike is still free from heartworms before we start the protection medicine. Mary will call you in seven to ten days as a reminder."

Then the notation is put into the veterinary software computer as one of the three Rs (Recall, Recheck, or Remind), and Mary gets the print-out on the appropriate morning from the client relations specialist.